HHS Evaluates Medical Necessity and Documentation Errors for Power Wheelchairs

Tuesday, July 12, 2011

HHS Evaluates Medical Necessity and Documentation Errors for Power Wheelchairs

Power wheelchairs paid for by Medicare are not always medically necessary, and claims for them frequently have insufficient documentation to support medical necessity, says a new report by the US Department of Health and Human Services (HHS) Office of Inspector General.

More than half (52%) of claims in the first 6 months of 2007 had insufficient documentation to determine whether the power wheelchairs for Medicare beneficiates were medically necessary. Based on records submitted by suppliers that provided power wheelchairs, 9% of the devices that were reimbursed were medically unnecessary. Of those, for 2% of claims, a less expensive type of equipment, such as a scooter or a manual wheelchair, should have been provided. For the remaining 7% of claims, the beneficiaries should have received a different type of power wheelchair than was provided.

Of the $189 million that Medicare allowed for power wheelchairs in the same time period, $95 million was for power wheelchairs that were medically unnecessary or had claims that were insufficiently documented.

Based on its findings of this and prior reports, HHS recommends that the Centers for Medicare and Medicaid Services enhance reenrollment screening standards for current DMEOPS suppliers; review records from sources in addition to the supplier, such as the prescribing physician, to determine whether power wheelchairs are medically necessary; direct contractors to review records from prescribing physicians, in addition to those from suppliers; and continue to educate power wheelchair suppliers and prescribing physicians to ensure compliance with clinical coverage criteria.

(Editor's note: This article was updated on July 16 to reflect the US Department of Health and Human Services Office of Inspector General as the correct author of the report. News Now regrets the error.)